Copies of the Form Can Be Downloaded From

Photographs
Ideally provide facial close up and a full length picture.
Full name of the person
Preferred name
Nick name
Maiden name
Date of Birth / Age
Race/ethnicity(please state)
Is English still their first language / Yes/No
General description
Height Weight
Hair Colour
Wig/hair piece / Yes/No
Wears glasses / Yes/No
Facial hair / Yes/No
Medical information
Has a dementia diagnosis or has memory problems / Yes/No
Other health issues e.g. Diabetes etc.
Takes medication – give details
Are they at any risk without it? / Yes/No
Yes/No
Current address
Lives alone / Yes/No
Lives with others if yes state who / Yes/No Details
Previous addresses
Indicate if childhood
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3
Most significant job
Places of work and addresses
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2
3
Favourite places 1
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Hobbies Bowling,fishing, parks visited etc.
Regular patterns /places visited
Doctors /Chemist/volunteering
Shops/Pub /café/Church
Regular or favourite holiday spots
Travel patterns, pastpresent
Buses What route, bus number?
Have they got a bus pass? / Yes/No
Trains
Station(s) travelled to and from
Car, Motorbike, Mobility Scooter
Still driving
Previously driven
Access to vehicle
Vehicle make, colour and registration / Yes/No
Yes/No
Yes/No
Access to money
Carrying cash
Bank card
Which bank and branch visited / Yes/No
Yes/No
Phone
Uses a mobile phone
Mobile number / Yes /No
Phobias/Fears
Phobiasthat may affect them
How might they react if frightened/worried?
Contact details of family/friend/carer, support worker
Name / Relationship (wife,son,daughter,friend, carer, support worker) / Contact Tel Number
Additional useful information

Copies of the form can be downloaded from:

South Yorkshire Police will ensure that any data kept on their data base is done in accordance with the Data Protection Act and the Management of Police InformationRulings and will not disclose data to any third party.

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